Provider Demographics
NPI:1346931508
Name:JOHNSON, KASHA M (AMFT)
Entity Type:Individual
Prefix:
First Name:KASHA
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6902 SVL BOX
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-5172
Mailing Address - Country:US
Mailing Address - Phone:310-930-4062
Mailing Address - Fax:
Practice Address - Street 1:13120 RIVERVIEW DRIVE
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY LAKE LAKE
Practice Address - State:CA
Practice Address - Zip Code:92395
Practice Address - Country:US
Practice Address - Phone:310-930-4062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist